Abstract: Disability evaluations that include a functional capacity evaluation constitute an emerging trend in evaluating workers with impairments and disabilities. Forces that are driving this trend for functionally-based evaluation, rather than traditional medical evaluations, include the Americans with Disabilities Act of 1990, escalating health care costs and managed care initiatives in workers’ compensation, the growing emphasis on return-to-work, and pressures from the legal arena. This article reviews the concept of the disability evaluation and contrasts the more traditional medical evaluation with a more innovative evaluation focused on job-related capacity and functional abilities. As a result, physicians and medical professionals are being…required to change their strategies for providing medical evaluations of workers, and employers are being required to reconsider how they utilize medical and disability information.
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Abstract: Functional capacity evaluation and impairment rating service delivery systems arc enjoying a growth unsurpassed by any ancillary service system in the health care industry. Medical, osteopathic, and chiropractic physicians arc establishing partnerships with allied health care professionals who are trained in functional capacity evaluation and impairment rating protocols. The resulting growth has led to new research in this specialized health care industry such that reliability and validity are being reviewed and credibility is being applied to both evaluative processes. One outcome from research has been the development of certification by two agencies in functional capacity evaluation and impairment rating. This…paper reviews the credentialling process and applied research which has been conducted in both evaluation environments and reviews the impairment rating and functional capacity evaluation process in detail.
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Abstract: The advent of computerized software and hardware programs, incorporating well researched data bases, including normative data, performance validation techniques, and video-biomechanical analysis, have improved the data acquisition process and accuracy of functional ability evaluations. The blend of this higher technology with reality based domain testing of worker function, allows for a more complete understanding of an individual’s true functional abilities. The principles of an objective assessment process will be integrated with a discussion of impairment as it applies to the peripheral nervous system. A case study will illustrate principles of permanent impairment and job-specific disability, utilizing the American Medical Association…Guides, 4th edition.
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Abstract: This article discusses the physician’s role in impairment rating as well as providing a historical perspective of the impairment rating guidelines. Philosophical and historical concepts of impairment rating systems are covered. Basic rules of impairment rating are explored with emphasis on the AMA Guides to the Evaluation of Permanent Impairment, Fourth Edition. Two case studies are discussed, with the rating of a neurological disorder discussed from both a plaintiff and defense attorney’s perspective. An overall legal perspective as it applies to impairment ratings is discussed as well as specific discussions surrounding the plaintiff and defense attempt to manipulate the impairment…rating in an impairment rating environment. This article helps the health care provider understand not only the impairment rating process, but delves into the motivations of attorneys, which can help the practitioner prepare for testimony in controverted cases.
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Abstract: The World Health Organization (1980) started the process of classifying consequences of disease and structuring a comprehensive model of illness by publishing its International Classification of Impairments, Disabilities, and Handicaps (ICIDH). Since that time, the field of brain injury rehabilitation has witnessed an evolution from biomedical to biopsychosocial conceptualizations of adaptation and outcome. In the current paper a vulnerability, stress and coping model is presented which incorporates psychological, social and cultural factors with biological factors to offer a schema for increasing understanding of variability in functional outcomes following brain injury. A procedural methodology with preliminary instruments for identifying important vulnerability…and stress and coping factors is presented, along with preliminary data which supports the utility of this approach, and suggestions regarding useful applications to clinical rehabilitation interventions. The importance of better understanding the variables that mediate the relationship between impairments, disability and handicap cannot be underestimated, and continued investigation of vulnerability and stress and coping formulations of adaptation following brain injury are clearly indicated.
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Abstract: Neuropsychologists have an important role in evaluating the cognitive and behavioral consequences of brain injury and neurologic dysfunction. Thoughtful application of neuropsychological assessment can assist in answering questions about functional capacity. We review common neuropsychological assessment methods, discuss various threats to test validity and provide a description of a clinical approach for assessing functional capacity. A relatively flexible testing approach is recommended, which requires the clinician to conceptually model functional skills.